title: Massive panniculectomy in the super obese and super-super obese: retrospective comparison of primary closure versus partial open wound management.
abstract: BACKGROUND
  The incidence of obesity is on the rise in the United States and worldwide. Complications following panniculectomy are higher for super obese patients, often requiring readmission and additional interventions. In this study, the authors compare the outcomes of patients who underwent primary closure of their resection wounds to the outcomes of patients who underwent initial open wound management with a negative-pressure dressing.
  
  
  METHODS
  The records of all patients who underwent panniculectomy between 2007 and 2012 were reviewed. Of 14 patients with a body mass index greater than 50, nine underwent primary closure and five were treated with open wound management. A retrospective chart review was performed.
  
  
  RESULTS
  There were no statistically significant differences in age or preoperative comorbidities, but body mass index was higher for the open wound management group (66.4 versus 58.9, p = 0.039). There were no statistically significant differences in mean operative time, resection weight, estimated blood loss, or hospital length of stay. The primary closure group had a 44 percent readmission rate and a 33 percent reoperation rate for wound complications. The open wound management group had no wound-related readmissions or secondary procedures for débridement.
  
  
  CONCLUSIONS
  Open wound management in the massive panniculectomy patient reduces hospital readmission and secondary operations. This case series provides reasons to support the consideration of open wound management following massive panniculectomy in the super morbidly obese patient population.
authors.affiliation: Cleveland, Ohio From the Department of Plastic Surgery, University Hospitals and Case Western Reserve University; Case Western Reserve University School of Medicine.
authors.forename: Matthew
authors.initials: M
authors.lastname: Brown
authors.forename: Paul
authors.initials: P
authors.lastname: Adenuga
authors.forename: Hooman
authors.initials: H
authors.lastname: Soltanian
mesh_terms: D058107:Abdominal Wound Closure Techniques; D061645:Abdominoplasty / Q000379:methods*; D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D010359:Patient Readmission; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014945:Wound Healing